Leopard spot retinopathy represents the initial sign of rhegmatogenous retinal detachment in children: a report of two cases

Abstract

Background: Leopard spots can appear in a variety of diseases; however, they are extremely rare in children with rhegmatogenous retinal detachment. This study presents two such rare cases in which leopard spot retinopathy was the initial manifestation of rhegmatogenous retinal detachment.

Case presentation: Case 1 involved a 4-year-old boy had previously been diagnosed with left eye uveitis and received systemic steroid therapy at a local hospital, but symptoms persisted. Extensive leopard-spot changes were observed in the posterior pole of the left eye and optical coherence tomography (OCT) showed multifocal, shallow retinal detachment in the left eye. Case 2 involved a 16-year-old girl who visited for decreased vision in her right eye. Examination of the right eye revealed leopard-spot changes at the posterior pole and a retinal hole in the fundus; multifocal retinal detachment was noted on OCT. In both cases, subretinal fluid was significantly absorbed after retinal laser photocoagulation or scleral buckling, with no recurrence of retinal detachment at late follow-up.

Conclusions: When leopard-spot changes are observed, the fundus must be carefully examined for any potential retinal holes, especially in pediatric patients.

Keywords: Bilateral diffuse uveal melanocytic proliferation (BDUMP); Leopard spot; Primary intraocular lymphoma (PIOL); Rhegmatogenous retinal detachment.

Fig. 1

Multi-model imaging in case 1. A: Fundus image showing leopard-spot lesions in the posterior pole of the left eye. B: Autofluorescence imaging highlighting the leopard-like pattern. C: Fundus fluorescein angiography (FFA) of the left eye showing no vascular leakage, with fluorescein staining observed at the border of retinal detachment. D: Ultra-wide-field fundus image revealing a retinal tear at the 3 o’clock position in the peripheral retina. E: Postoperative retinal reattachment, with the tear located at the site of the buckle. F: Infrared fundus imaging showed leopard-spot lesions in the posterior pole of the left eye preoperatively. Yellow arrows indicate B-scan images in G, I and K, and green arrows indicate B-scan images in H, J and L. G, H: Optical coherence tomography images showing multifocal shallow retinal detachment in the left eye. I, J: Significant improvement in superficial macular detachment 5 months after surgery, with resolution of the multifocal retinal detachment in the posterior pole. K, L: After 2 years, the patient’s fundus remained stable with no recurrence of retinal detachment

Fig. 2

Multi-model imaging in case 2. A: A round hole is seen at the 11 o’clock position in the patient’s right eye. B: Fundus photo after laser photocoagulation treatment. C: Infrared fundus imaging shows leopard-spot lesions in the posterior pole of the right eye before treatment. Green arrows indicate B-scan images corresponding to panels D, F and H. Yellow arrows correspond to B-scan images in panels E, G and I. D, E: Optical coherence tomography of the right eye showing multifocal retinal detachment. F, G: Follow-up examinations showing improved multifocal retinaldetachment. H, I: After 1 year, the OCT showing complete absorption of subretinal fluid